ENT/Optho

Question 1

When should an infant first see the dentist?

Answer 1

Within 6 months of their 1st tooth or no later than 12 months old

Question 2

How should the first teeth in infants be cared for?

Answer 2

First teeth appear usually @ 6 months

• Clean at least OD, ideally before bedtime
• Soft toothbrush for babies
• NO toothpaste (not until 2 years old)

Question 3

When can children start using toothpaste?

Answer 3

2 years of age (unless otherwise directed by dentistry)

Question 4

What is the most effective test for amblyopia?

Answer 4

Amblyopia: reduced vision in absence of ocular disease when brain doesn’t recognize input from eye
Visual acuity

Question 5

At what age do infants develop following faces?

Answer 5

birth to 4 weeks

Question 6

What age do children have visual acuity with appropriate chart?

Answer 6

3.5 years

Question 7

What eye movement is decreased with a CN 6 nerve palsy?

Answer 7

Decreased abduction of the eyes/decreased lateral gaze

Question 8

What is the most common suppurative complication of AOM?

Answer 8

Mastoiditis

Question 9

What are the two most common bacteria implicated in mastoiditis?

Answer 9

S. pneumoniae, S. pyogense

-H. infleunzae & S. aureus are less common

Question 10

What are the potential intracranial complications associated with mastoiditis?

Answer 10

• Meningitis
• Temporal lobe or cerebellar abscess
• Epidural or subdural abscess
• Venous sinus thrombosis

Question 11

What are the risks of N. gonorrhea ophthalmia neonatorum?

Answer 11

Corneal ulceration, globe perforation, permanent visual impairment

Question 12

True or False. The CPS recommends routine prophylaxis for N. Gonorrhea ophthalmia neonatorum.

Answer 12

False. Recommended to NOT routinely prophylax but if mandated, consider 0.5% erythromycin.

Question 13

How do you manage an infant who was exposed to a mother with N. gonorrhea during delivery?

Answer 13

1. Conjunctival swab to be sent for culture for N. gonorrhea
2. CTX 50mg/kg IM x1
3. If unwell do FSWU

Question 14

What is the most common cause of sensorineural hearing loss?

Answer 14

Genetic

Question 15

What is the most common non-genetic cause of sensorineural hearing loss?

Answer 15

CMV

Question 16

A 10 year old female presents with B/L visual loss, H/A and pain with EOM. An afferent pupillary defect is noted on exam. You are suspicious of the diagnosis of optic neuritis. What disease is she at risk of developing?

Answer 16

MS

Question 17

A boy presents with a history of 1 week of sore throat, now he is having difficulty opening his mouth and has dysphonia. What is the most likely diagnosis?

Answer 17

Peritonsilar abscess

Question 18

A child presents with unilateral eye watering and conjunctivitis. On exam, there are periauricular LNs noted. What is the likely diagnosis?

Answer 18

Viral conjunctivitis
-Presents in adolescent/adults
-Mostly during summer
-Watery discharge, unilateral, assoc. w/ periauricular nodes
Adenovirus: may present with pharyngitis or PNA
Enterovirus: may present as an epidemic
Mgt: supportive

Question 19

A child has bilateral vocal cord paresis. What test do you need to do?

Answer 19

MRI head

DDx: Arnold Chiari malformation, posterior fossa tumor, meningomyelocele, cerebral agenesis, hydrocephalus

Question 20

What is on the DDx for leukocoria?

Answer 20

• Cataract
• Retinoblastoma
• Retinopathy of prematurity
• Retinal detachment
• Retinoschisis

Question 21

What is a ranula and what is the treatment?

Answer 21

Ranula: pseudocyst assoc. w/ the sublingual glands and submandibular ducts
Management: excision of sublingual gland

Question 22

What is the order of development of the sinuses?

Answer 22

My Extremely Smelly Friend
Maxillary: present @ birth, radiologic @ 4-5 months
Ethmoid: present @ birth, radiologic @ 1 year
Sphenoid: not present @ birth, develops first 2 yrs, radiologic @ 4 years
Frontal: not present @ birth, size increases to teen yrs, radiologic @ 6 years

Question 23

What other anatomical anomaly do you need to consider if you visualize a bifid uvula?

Answer 23

Submucous cleft
-Bifid uvula may be a sign of submucous cleft, which occurs when the palate mucosa is intact but underlying palatal musculature is dehiscent

Question 24

When do you refer for ear tubes?

Answer 24

• Recurrent AOM w/ middle ear effusion
• B/L OM w/effusion (>3m) w/ conductive hearing loss
• Unilat/Bilat OME (>3m) w/ other problems (behaviour, pain, balance etc.)
• Uncommonly: complications of AOM (mastoiditis), lack of response to medical tx, chronic retraction of TM

Question 25

A child presents with nasal trauma. What must you rule out on physical exam?

Answer 25

Rule out septal hematoma - this needs emergent drainage as it can cause dissolution of the cartilage. Also, note that it can present later if someone comes back a few days later with extreme pain and fever = hematoma has now abscessed.

Question 26

A 13 year old M presents with severe chronic unilateral epistaxis. Labs are all normal. What is your next step in management?
A. Repeat coags
B. Transfuse prophylactically
C. Refer to ENT for endoscopy/possible imaging
D. Start on nasal steroids

Answer 26

C. Refere to ENT for endoscopy/imaging

-Looking for Juvenile Nasal Angiofibroma

Question 27

What is the management for TM perforation?

Answer 27

• Most heal within 6 weeks
• Otic drops (ciprodex)
• Repair @ 9-10yrs
• Referral if otorrhea is persistent/perforation visible

Question 28

What are the absolute indications for adenotonsillectomy?

Answer 28

-OSA (AHI>5/hr) and large tonsils
-Cor pulmonale
-Suspected malignancy
-Hemorrhagic tonsillitis
-Severe dysphagia
(Recurrent tonsillitis is a relative indication)

Question 29

What are the two most common congenital neck masses in children?

Answer 29

Branchial cleft cyst and thyroglossal duct cyst